Electrocardiographic morphology recognition system

ABSTRACT

AN ELECTROCARDIOGRAPHIC MONITORING SYSTEM WHICH RECOGNIZES QRS COMPLEXES, THEIR RHYTHM AND MORPHOLOGIES. THE MORPHOLOGIES OF THE QURS COMPLEXES ARE MEMORIZED DURING A LEARNING INTERVAL AT THE START OF MONITORING. THEREAFTER, DIFFERENT MORPHOLOGIES ARE IDENTIFIED AS ABNORMAL. EACH QRS COMPLEX IS RECOGNIZED BY DIFFERENTIATING IT, FORMING VARIOUS PRODUCT SIGNALS OF ITSELF AND ITS DERIVATIVE, AND REGISTERING THE SEQUENCE IN WHICH THE VARIOUS PRODUCT SIGNALS EXCEED AND FALL BELOW THRESHOLD VALUES. THE SYSTEM ALSO CONTINUOUSLY UPDATES A 10-SECOND AVERAGE OF THE R-R INTERVAL IN ORER TO IENTIFY PREMATURE AND LATE BEATS, AND COMPENSATORY PAUSES.

Nov. 2, 1971 J HARRls 3,616,71

ELEOTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April 50, 1969 13 Sheets-Shoot 1 ac C B J AD B DAD ADIBC'D A BC GEORGE J. RIS

Nov. 2,, 1971 HARmS 3,616,781

ELECTHOCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April 50. 1969 13 Sheets-Sheet 2 F BG. 2

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STATE F/F-I F/F-Z FIE-3 F/F-4 o o o o o I 0 0 0 2 I I 0 0 3 I o 4 5 o 0 o FIG. 4 e o o 1 1 0 a o I o 9 STATE Z-STROBE 0 STATE S-STROBE H STATE 4STROBE lN ENTOR 12 STATE 6- STROBE GEORGE IHARRIS I5 STATE Y-STROBE BY l4 STATE 8- STROBE M I5 STATE l- STROBE I6 STATE 5- STROBE ATTORNEY J. HARRIS 5 ELECTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April $9, 1969 13 Sheets-Sheet 5 TINST -RESET RAMP INTERVAL RAMP +I DH +IFF COMP. PAUSE RAHP lNVENTOR GEORGE THARRIS ATTORNE LATE ARE A DETECHON EARLY AREA DETECTION NOV. 2., 1971 J HARRIS 3,616,791

ELECTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April .330, 1969 13 Sheets-Sheet L AT TO RN EY ELECTROCARDIOGRAPHIC MORPHOLOGY RECOUNI'IIUN SYSll-lM Filed April 30. 1969 G. J. HARRIS Nov. 2, 1971 is Sheets-Sheet a \HMEEG Emir:

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ELECTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April 30. 1969 13 Sheets-Sheet 11 \Nvl- NIOH GEORGE; J". HARM) ATTORNEY Nov. 2, 1971 G. J. HARRlS ELECTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM Filed April 50. 1969 13 Sheets-Sheet 1! INPUT AND OUTPUT CIRCUIT 20 United States Patent 3,616,791 ELECTROCARDIOGRAPHIC MORPHOLOGY RECOGNITION SYSTEM George J. Harris, Framingham, Mass, assignor to American Optical Corporation, Southbridge, Mass. Filed Apr. 30, 1969, Ser. No. 820,554 Int. Cl. A61b 5/04 U.S. Cl. 1282.06 A 58 Claims ABSTRACT OF THE DISCLOSURE An electrocardiographic monitoring system which recognizes QRS complexes, their rhythm and morphologies. The morphologies of the QRS complexes are memorized during a learning interval at the start of monitoring. Thereafter, different morphologies are identified as abnormal. Each QRS complex is recognized by differentiating it, forming various product signals of itself and its derivative, and registering the sequence in which the various product signals exceed and fall below threshold values. The system also continuously updates a -second average of the R R interval in order to identify premature and late beats, and compensatory pauses.

This invention relates to electrocardiographic monitoring system, and more particularly to such systems which automatically detect abnormal ECG waveforms.

It is common today, in the intensive care units of many hospitals, to monitor continuously the ECG signal of a cardiac patient. It is, of course, impractical to station continuously a doctor or a trained nurse at the bedside of the patient for the purpose of observing a trace of the ECG signal on a scope. In some cases, what is done instead is to produce a continuous trace of the ECG signal for periodic review by trained personnel. However, this is also impractical not only because of the high cost but also because the trace requires a considerable amount of time for its review. It has been suggested to overcome these problems by triggering a short trace only when an abnormality in the ECG signal is detected. Various relatively unsophisticated systems have been proposed in the prior art for determining such abnormalities, e.g., heartbeat rate detection circuits, etc.

One of the main difficulties in the design of any system of this type is that the normal ECG signal varies from patient to patient. Most normal ECG waveforms include P, Q, R, S and T waves, the QRS complex containing most of the useful information. But the waveform varies widely from patient to patient and each patient can have a different normal electrocardiogram. It is for this reason that it is exceedingly difficult to design equipment which can detect abnormal heartbeats. Except for certain ver'y pronounced conditions, there is no such thing as a typical abnormality for all patients.

The problem is not only with the shape of ECG waveform. There is also no such thing as a normal timing of the ECG pulses. (Of course, a normal range can be defined for all patients, but when a patient is to be closely monitored it is best to detect deviations from his particular norm, rather than rates outside the much broader normal range.) The time periods which make a pulse premature or late vary not only from patient to patient, but from time to time with the same patient as well. What is important wih respect to the timing of the ECG signal of any individual patient is that deviations from the norm for that particular time of day be detected, rather than deviations from a broad range which may characterize the beating of the patients heart over a relatively long period of time.

Similarly, the timing and shape of a patients ECG signal may be normal, yet the width (the integral of the rectified waveform) of any signal waveform may be excessive. Again, the normal width of the waveform varies not only from patient to patient, but from time to time with the same patient. All of these factors make it exceedingly difiicult to design a system which is satisfactorily detects abnormalities in the ECG signal of a patient.

It is a general object of this invention to overcome the aforesaid problems with the provision of an electrocardiographic morphology recognition system which is capable of learning the normal characteristics of any patients ECG signal, and which thereafter detects deviations from the learned characteristics and controls the appropriate alerting actions.

In the illustrative embodiment of my invention, the ECG signal from the patient is recorded on a two-second endless tape belt as is known in the art. Whenever an abnormal signal is detected, the two previous seconds of the ECG signal are recorded on a trace together with the ECG signal during the next second. Such arrangements are well known in the art. My invention pertains to the circuitry for enabling the system to learn the normal patterns and then to automatically respond to deviations from them.

The first learning/ detecting sub-system pertains to the shape of the QRS complex of each ECG waveform. The ECG signal is differentiated and various analog functions of the ECG signal and its derivative are developed. A set of flip-flops is provided to define the system state. The flip-flops cycle from an initial state during the period of each heartbeat. The instantaneous system state depends both on the previous system state and the instantaneous .values of the analog functions formed from the ECG signal. The final system state is in effect a representation of the sequence of the function values, which sequence is in turn a function of the shape of the QRS complex. i

During a 15-second learning interval, the system registers all of the final states which are developed for the individual ECG waveforms occurring during the interval, except those associated with premature beats. Thereafter, the system compares the final state represented by the series of flip-flops with the final states included in the learned patterns. If any ECG waveform results in a final state which is not one of those previously registered (or learned), it is an indication that the morphology of the waveform is of interest to the cardiologist, and a 3-second trace is made.

The system is designed to learn eight different final system states and to detect subsequent deviations from them. The state sequencing has been designed to terminate in a respective state for each of eight function value sequences which correspond to respective relatively common ECG waveshapes. While these waveshapes are the most frequent, they are by no means universal. It is to be expected that in some patients the normal ECG waveshapes will be considerably different from all of those in mind when the state sequencing was designed. This is of no consequence. The flip-flops still cycle in accordance with the instantaneous values of the analog functions, and during the 15-second learning process the system still ends up in several final system states which can be considered normal for that patient. Thereafter, if any final system state is different from all of those previously learned, an abnormality is detected to control the trace. Thus, it is not necessary to pre-program the system with every conceivable ECG waveform. All that is necessary is to provide a mechanism for analyzing the ECG signal and to enable the system to remember the results of the analysis during the learning process. Subsequent different results are treated as abnormal.

As described above, it is not possible for the system to learn a normal timing sequence even for any individual patient because the normal time separation of the pulses for any patient can vary from time to time. The important criterion is a deviation from the average time separation over the preceding few beats. A circuit is provided to determine the average time separation between heartbeats. The instantaneous time separation between successive pulses is then monitored and deviations by more than pre-set percentages from the average time separation result in indications of premature beats, late beats and compensatory pauses. These deviations from the continuously learned normal (or average) timing sequence can be programmed to trigger the 3-second trace.

Similar remarks apply to the width measurement. The widths of a few successive waveforms are continuously averaged and an instantaneous deviation from it can be programmed to trigger the trace.

Depending on the condition of the patient, the cardiologist may desire a trace only for particular types of abnormalities. For example, he may want to examine the -ECG signal only following a late pulse, or only following a premature beat, or only following an abnormal waveshape, or any combination of these, etc. A set of switches is provided to pre-program the system to control the trace following the detection only of an abnoramlity of interest to the cardiologist. A counter is also provided to count the number of ventricular premature beats so that this information is available even if the cardiologist does not pre-prograrn the system to generate any traces.

Further objects, features and advantages of my invention will become apparent upon a consideration of the following detailed description in conjunction with the drawings, in which:

FIG. 1 illustrates six typical QRS waveforms and the analog functions derived therefrom in the illustrative embodiment of the invention, and further depicts the timing sequence of the functions which determine the final system state for each of the six QRS waveforms;

FIG. 2 illustrates two additional waveforms which may occur in some ventricular premature beats;

FIG. 3 is a state diagram illustrating the sequencing of the system state in accordance with the sequencing of the function inputs of FIG. 1;

FIG. 4 is a table showing the relationship of the states of the four individual flip-flops which together define the system state;

FIG. 5 is a timing diagram which will be helpful in the analysis of the circuitry which determines the occurrence of a compensatory pause;

FIG. 6 is a timing diagram which will be helpful in the analysis of the circuitry which determines an abnormality in the width (area) of an ECG waveform;

FIGS. 7-12B illustrate schematically an illustrative embodiment of my invention;

FIG. 13 shows the arrangement of FIGS. 7-12B; and

FIG. 14 is a slightly different input and output circuit which can be used in lieu of that shown in FIG. 7.

FIGS. 1 and 2-eight typical QRS waveforms and the functions derived therefrom for controlling the cycling of the system state The top line of FIG. 1 illustrates six typical QRS waveshapes W9 through W14, each being a part of the overall ECG signal, e. The suflixes 9 through 14 correspond to the final system states 9 through 14 to be described below. For example, with a QRS waveform having the shape of W11, the system ends up in state 11.

Each of the straight-line segments which partially defines one of the waveforms W9 through W14 is identified by the letter S or F. The former represents a slow-rising or slow-falling segment, i.e., a small slope. The latter represent a fast-rising or fast-falling segment, i.e., a large slope. Waveforms W9 through W11 and W12 through W14 are two complementary sets, With individual pairs 4 of the waveforms being of opposite polarities. For example, waveforms W9 and W12 have the same shape but are inverted with respect to each other.

The second line in FIG. 1 shows the derivative de/dt of each of the QRS waveforms W9 through W14. The magnitude of the derivative of each F line segment is twice the magnitude of the derivative of each S line segment, since the derivative of each waveform is simply the magnitude of the slope of the waveform at any time. The polarity of the derivative of any waveform is positive when the slope of the waveform is positive, and is negative when the slope of the waveform is negative.

The waveforms illustrated at the top of FIG. 1 are theoretical in that a typical QRS waveform does not consist wholly of straight-line segments. Therefore, the derivatives shown in the second line of FIG. 1 are also theoretical. In actual practice, the QRS waveforms and their derivatives have curved portions. The dotted curves in the second line of FIG. 1 show the shapes of the functions which are actually derived in practice. The curved portions of the derivative functions correspond to curved portions in the actual QRS waveforms. For an understanding of the invention it is not necessary to analyze the actual waveforms seen in practice. As discussed above, for each QRS waveform the system ends up in a particular final system state. During the 15-second learning process, the final states which are registered correspond to the normal waveforms, whatever they are. Thereafter, final system states which do not correspond to those previously learned represent abnormalities. Theoretical waveforms are easier to understand than those actually found in practice, and in no way detract from an understanding of the invention itself.

The third set of waveforms in FIG. 1 show the product of each QRS waveform and its derivative for each of cases W9 through W14. The two plus signs in the function to the left of the diagram indicate that the product A which is formed only takes into account the positive portions of any waveform and its derivative. Thus, in the case of waveform W12 which is never positive, the product must necessarily be zero at all times. Each of the functions in the third line of FIG. 1 is positive only when both of its two factors are positive, and the instantaneous magnitude of the product is dependent on the magnitudes of both the waveform and its derivative. The various products which are shown in FIG. 1 are derived from the waveforms themselves and the actual derivatives shown by the dotted curves in the second line of the diagram.

The fourth set of waveforms have a similar interpretation except that only the negative portions of the ECG waveforms and their derivatives contribute to the output B. Only if both of the two input functions e and ae/dt are negative is an output produced.

The multiplier which produces the C function, shown in the fifth line of FIG. 1, has as both of its two inputs the derivative of the ECG signal. However, only the negative portions of the derivative are considered, i.e., the C function is non-zero only when de/dt is negative. Similarly, the D function, produced by a fourth multiplier, operates only on the positive portion of the derivative.

At the bottom of each column there is shown the sequence in which the various multiplier outputs (A, B, C and D) go positive. In the case of Waveform W9, functions A and D go positive together, and are followed by function C. This is shown by the notation AD,C.

In the case of Waveform W10, A and D pulses are produced together, followed by B and C pulses produced together. This condition is shown as AD,BC. However, it is possible for the C multiplier output to go positive shortly before the B multiplier output, the situation actually shown in the drawing. For this reason, a second possible sequence is shown for waveform W10, namely, AD,C,BC. First, A and D go positive together, then C, followed by C together with B. It should be noted that in the case of waveform W10 there is a small D output toward the end of the sequence. However, the magnitude of the D output is not sufficient for the gates in the system to respond to it. For this reason, the D function is not included in either of the function sequences for the case of waveform W10.

In the case of Waveform W11, the A and D signals are produced together, followed by the B and C signals, followed by the D signal. The sequence is shown at the bottom of the third column as AD,BC,D. However, it is possible for the C signal to go positive slightly before the B signal, as actually shown in the drawing. For this reason the alternative sequence AD,C,BC,D is also shown for waveform W11.

The sequences for waveforms W12 through W14 have similar interpretations. It should be noted that while waveforms W12 through W14 are the inverse of waveforms W9 through W11, the function sequences for the pairs of waveforms are not related. It is for this reason that the system has been designed to take into account all six waveforms, rather than only three of them.

FIG. 2 shows two additional QRS waveshapes, W15 and W16, which may occasionally occur in some ventricular premature beats (VPBs). The early part of each of these complexes is similar to that of W9 or W12, but the later part of each complex is much slower than that of W9 or W12. The morphology detection circuit to be described below can detect the A and D functions going positive at the beginnng of waveform W15 (the first part of waveform W15 is similar to waveform W9 so that the A and D functions can be generated in both cases at the beginning of the wave-forms), or the B and C functions going positive at the beginning of waveform W16 (the first part of waveform W16 is similar to waveform W12 so that the B and C functions can be generated in both cases at the beginning of the waveforms). Each of the C and D multipliers has two inputs-either positive derivatives or negative derivatives. If the late portion of the waveform is slow, the derivative in each case will be small. Consequently, it is possible that following AD an undetectable output will be generated from multiplier C, or that following BC an undetectable multiplier output will be generated from multiplier D. The system is designed to register the first of these conditions (W15-A and D together, followed by undetectable C), or the second (W16-B and C together, followed by undetectable D). The system has a total of eight final system states 9 through 16 corresponding to the six waveforms W9 through W14, and the two waveforms W15 and W16.

FIG. 3 is a state diagram which shows the progression of the system state from state (following a reset pulse prior to each heartbeat) to one of the final states 9 through 16. If the system receives an AD input (that is, the outputs of the two multipliers which generate the A and D functions are energized together), the system jumps from state 0 to state 1. If a C input is then received, the system moves from state 1 to state 2. If the next input is BC, the system moves to state 3. Alternatively, if the system is in state 1 and a BC input is applied, the system jumps from state 1 to state 3. This sequence insures that the system cycles to state 3 for waveform W10 (see FIG. 1) whether or not the C input is actually received before the B input. If the system is in state 3 and a D input is received, it moves to state 4.

The left side of the state diagram shows the cycling of the system state for wave forms W9, W10, W11 and W15. In the case of waveform W15, there is only an AD input and the system state cycles to state 1. In the case of waveform W9, where there are only AD and C inputs, the system cycles to state 2. For waveform W10, where the inputs are AD,BC or AD,C,BC, the system cycles to state 3. The input sequence for waveform W11 is the same as that for waveform W10 except that there is an additional D input at the end of the sequence. For the W11 waveform, the system goes to state 4 rather than remaining in state 3.

Similarly, for waveforms W16, W12, W13, and W14, the system cycles to respective states 5, 6, 7 and 8, as shown in FIG. 3.

With the system sitting in one of states 1-8, if a strobe pulse is generated, the system jumps to one of terminal states 9 through 16 (corresponding to wave forms W9 through W16) as shown in the state diagram of FIG. 3. In case the only input sequence was AD, the system moves from state 0 to state 1 and remains in state 1. In such a case, the strobe pulse causes the system to jump to state 15 (since for waveform W15 of FIG. 2 an AD combination can be generated). Similarly, if the only input sequence was BC, the system is in state 5 when the strobe pulse is applied and it ends up in state 16 (since for waveform W16 of FIG. 2 a BC combination can be generated).

Terminal states 9 through 16 are used during, both the learning and monitoring sequences. It is the terminal states which are first learned that are later used during monitoring to determine if an abnormal waveform has been detected. At all times, after the necessary information has been determined from one of the terminal states 9 through 16, a reset (R) pulse resets the system and causes it to revert to state 0 preparatory to examination of the next ECG waveform.

FIG. 4 shows the states of four flip-flops F/F-l through F/F-4 for each of the system states 0 through 8. These flip-flops will be described in detail below. The states of the flip-flops do not change to represent terminal states 9 through 16. The system jumps to (or, more accurately, simply verifies the existence of) terminal state 15, as indicated in the table of FIG. 4, if it is in state 1 when the strobe pulse is generated. Similar remarks apply to intermediate states 2 through 8 and terminal states 9 through 14 and 16. The table of FIG. 4 is an alternative way to define the state diagram of FIG. 3. Both figures will be considered below in the detailed description of waveform recognition circuit 50.

FIG. 7input and output circuit-Part I Patient 35 is connected in the usual manner to a conventional electrocardiographic amplifier 15. The gain of the amplifier can be controlled by potentiometer 33 as is known in the art. The amplifier produces two ECG output signals, identical except for their opposite polarities. The positive output signal, +e, is extended to the input of magnetic tape recorder (tape loop) 32 so that a delayed, 2-second display of the patients ECG signal is available. The output of recorder 32 is extended to the input of ECG trace recorder 22. When gate ND94 operates, as will be described below, a 3-second trace of the ECG signal is made. The gate operates after it is determined that the previous heartbeat or heartbeats were different from normal beats and should be recorded. For this reason, the +e signal is recorded on a 2-sec0nd tape loop in recorder 32, as is known in the art. When gate ND94 operates, the two seconds of the past ECG signal are recorded on the trace recorder 22 followed by the next second of the signal.

Input and output circuit 20 includes a noise detector circuit. The +2 output of amplifier 15 is extended through high-pass filter 46 (to attentuate relatively low frequencies) to both diode 29 and amplifier 31 having a gain of 1. The amplified output is applied to diode 30. The signal at the junction of the two diode cathodes is thus a fully rectified ECG signal, and the signal is fed to one input of comparator 26. Potentiometer tap 25 is connected to the other input of the comparator. As long as the rectified ECG signal at the one input of the comparator is lower in magnitude than the voltage on tap 25, the comparator output is high. However, when the rectified ECG signal goes above the threshold voltage, the comparator output goes low. Every time the comparator output goes low, one-shot multivibrator 27 is triggered. The multivibrator is triggered a number of times equal to the number of times the rectified ECG signal voltage goes above the voltage threshold level. The rate of operation of the multivibrator is thus proportional to the rate of the threshold crossings of the rectified ECG signal.

Each multivibrator pulse delivers a charging current to capacitor 28. The voltage across the capacitor is thus proportional to the average number of times the multivibrator is triggered.

One input of comparator 23 is connected to potentiometer tap 24. The other input is connected to capacitor 28. The NOISE output conductor is normally held at a high potential by the comparator. However, when the voltage across capacitor 28 exceeds the voltage on tap 24, the comparator output goes low. Potentiometer tap 24 is adjusted to a level corresponding to the maximum noise threshold. In the presence of excessive noise, i.e., a high frequency content in the ECG signal, the voltage across capacitor 28 exceeds the threshold level and the NOISE conductor goes low. Gate ND95 operates to cause conductor +NOS to go positive. (The operation of an ND gate is described in the next section.) This conductor is connected to one input of gate ND94, and when it is positive it prevents the gate from triggering the 3-second trace even if the remaining circuitry detects a requirement for a trace. In the presence of excessive noise a trace is not made. Conductor +NOS is also extended to morphology detector circuit 60 to prevent the operations of gates ND72 and ND96 in the presence of noise, as will be described below.

The +e output of amplifier is extended to the input of R-way detector 69 in timing control circuit 30. The R-wave detector detects the downward sloping portion of the QRS complex in each ECG waveform, and its operation, together with the operation of the timing control circuit, will be described below.

The +e output of amplifier 15 is also extended to the input of diiferentiator '44. The output of the dilferentiator is the derivative of the ECG signal, and two opposite polarity signals are developed as shown. These signals are extended to the inputs of the four multipliers M1 through M4, as are the +2 and e signals themselves. Consequently, the multipliers, between them, can form the four function products depicted to the left sides of the four lowest waveform diagrams in FIG. 1. These outputs of the multipliers are indicated on FIG. 7. Each multiplier output is grounded or positive only-and it is positive only when both input signals to the multiplier are positive.

The output of each multiplier is connected to the J input of a respective one of flip-flops F /F-A through F/F-D. The output of each multiplier is also inverted by a respective inverter and the inverted signal is applied to the K input of the respective flip-flop.

Clock 53 in timing control circuit 30 operates at a kHz. rate. The clock generates a succession of squarewave pulses. The output of the clock on conductor CLK is connected to the C (clock) input of each of flip-flops F/F-A through F/FD. It is only the negative step :of each clock pulse which can trigger a change of state of any flip-flop. In general, various conductors in the drawings are identified by a letter sequence preceded by a or sign. A designation indicates that when the conductor goes high in potential, the signal controls certain switching functions in the system. Similarly, a designation indicates that when the conductor goes low in potential, the signal controls certain switching functions in the system. It is a negative step on conductor CLK which controls various switching functions in the system and thus the CLK notation is preceded by a sign.

The system includes various J-K flip-flops. If the J input of one of these flip-flops is high and the K input low, the negative clock pulse causes the flip-flop to be set. (Thus, for example, if the output of multiplier M1 goes positive, the next clock pulse causes output conductor A of flipflop F/F-A to go high and output conductor Xto go low.)

If the J input of a flip-flop is low and the K input is high when a clock pulse is generated, the flip-flop is reset with the output conductors switched to the opposite polarities. (Thus, for example, if the output of multiplier M1 goes to zero, the J input of flip-flop F/F-A is low and the K input is high, and the next clock pulse causes the flip-flop to be reset with conductor A going low and conductor A going high.) If the J and K inputs of a JK flip-flop are both high, the flip-flop changes state when a clock pulse is generated. (Since the J and K inputs of flip-flops F/F-A through F/FD are always of opposite polarities, the both high condition does not arise.) If both the J and K inputs of a J-K flip-flop are low when a clock pulse is generated, the state of the flip-flop is unaffected. (This condition is also not possible in the case of flip-flops F/F-A through F F-D since the J and K inputs of each flip-flop are always of opposite polarities.) Each J-K flip-flop is also provided with set (S) and reset (R) terminals. Considering any flip-flop with two output conductors F and?) if the reset terminal is low the flip-flop is reset with conductor F going low and conductor F going high. Conversely, if the set input is low, the F conductor goes high and the F conductor goes low. The operation of the set and reset inputs is independent of the state of the clock input. (In the case of each of flip-flops F/F-A through F/F-D, the set and reset terminals are both connected to positive potentials and the flip-flops are unaffected by the set and reset inputs.)

With respect to each of (flip-flops F/FA through F/F-D there are only two possible inputs. Either the J input is high and the K input is low, or vice versa. (By high is meant a multiplier output high enough to affect the state of the flip-flop.) In the former case, the next clock pulse to arrive sets the flip-flop with the upper output conductor of the flip-flop going high and the lower output conductor going low. Thereafter, the flip-flop remains set as succeeding clock pulses are generated. When the respective multiplier output goes to zero, the J input goes low and the K input goes high, and the next clock pulse causes the flip-flop to reset. The clock pulses are applied at such a rapid rate that the iflipaflop states almost instantaneously represent the positive or zero outputs of the respective multipliers. In the description below, the inputs to recognition logic circuit 50 are indentified as A, B, C and D. An A input, for example, is that where conductor A is high and conductor K is low, i.e., flip-flop F/F-A is in the set state as a result of the output of multiplier M1 going positive.

FIGS. 11A and 11Brecognition logic circuit Recognition logic circuit 50 operates to examine the four flip-flops F/ F-A through F/F-D, and depending on the sequence of their energizations during the appearance of any ECG waveform to cause one of the eight output conductors 51-9 through 51-16 to go low. Each of these conductors is normally high in potential and when one of them goes low it is an indication that one of the final system states 9-16, indicated on FIG. 3, has been reached.

Referring to FIG. 3, it is seen that a transition is made to one of the eight terminal states only with the generation of the strobe pulse. Accordingly, one of the eight conductors 51-9 through 51l-1l6 goes low only when the strobe pulse is generated. This pulse is not generated until after the ECG waveform has been analyzed by the recognition logic circuit. While any individual ECG waveform is being examined, during a period typically slightly shorter than a second, flip-flops F/F- A through F/F-D are energized in a sequence dependent upon the shape of the waveform. The recognition logic circuit continuously changes the states of flip-.fiop F/F-ll through F/F-d (FIG. 11B) in accordance with both the present states of these fiipaflops and the particular sequence in which flip-flops F/F-A through F/F-D are successively set and reset. Depending upon the final states of the former four flip-flops at the time the strobe pulse is generated, one of the eight output conductors 51-9 through 5116 is energized. The operation of recognition logic circuit 50 is summarized in the state diagram of FIG. 3 and the table of FIG. 4.

The recognition logic circuit includes two types of gates, NAND and NOR. The NAND gates have ND prefixes in their designation, and the NOR gates have NR prefixes. Each gate has two or more input conductors. The NAND gate is of the AND type, but the little circles connecting the input conductors to the gate inputs represent inverters, and effectively convert the basic AND gate to a NAND gate. If all inputs to an AND gate are high, the output is similarly high. If at least one input is low, the output is low. Because each input to the basic AND gate in any NAND gate is inverted, it is apparent that if at least one input is high, the corresponding input to the AND gate is low, and the output of the gate is low. Consequently, only if all inputs are low does the NAND gate output go high. It should be noted that if one input of a two-input NAND gate is grounded, the gate serves as an inverter. If the other input is low, the output is high, and vice versa.

The NOR gate is of the OR type, but the little circle at the gate output represents an inverter. A basic OR gate has its output energized if at least one of its inputs is high. Because of the inverted output of a NOR gate, the output is low if at least one of the inputs is high. The output goes high only if all inputs are low. If a NOR gate has only two inputs, one of which is grounded, it functions as an inverter. If the other input is low, the output is high; if the other input is high, the output is low.

Some of the NAND gates in recognition logic circuit 50 include a symbol such as X Y. Such a symbol is used to indicate that the gate controls a transition of the system from state X to state Y upon the generation of a clock pulse on conductor CLK.

Between the detection of successive ECG waveforms, the output of each of multipliers M1 through M4 in FIG. 7 is low. Since the output of each multiplier is connected to the J input of a respective one of flip-flops F/ FA through F/FD, the J input of each of the flipflops is low. Since the output of each multiplier is coupled through an inverter to the K input of the corresponding flip-flop, the K input of each flip-flop is high. In such a case, the clock pulses on conductor CLK keep the flipflops reset. Conductors A through D are low and conductors K through D are high. (Actually, outputs A, B, C and D from flip-flops F/F and F/F-D- are not required, and accordingly the corresponding conductors are not shown in the drawing.) Once a [flip-flop is reset by a first clock pulse, the succeeding clock pulses have no effect. The flip-flop remains reset. As soon as a multiplier output goes high, however, the next clock pulse causes the associated flip-flop to be set with a corresponding change in state in the output conductors.

Referring to FIG. 3, it is seen that the system starts ofif in state with each of flip-flops F/F1 through F/F-4 being in the 0 state. Conductor R is connected to the reset terminal of each of the flip-flops. Prior to the analysis of each detected ECG waveform, this conductor goes negative (as will be described below) to reset all four flip-flops. Thus, initially all of conductor FT, F2, F3 and F1 are high, and all of conductors F1, F2, F3 and F4 are low. The state diagram shows that either one of two inputs, AD or BC, results in a new system state when the system starts oif in state 0. Consider the former. In such a case, the outputs of multipliers M1 and M4 go high together and the next clock pulse switches flip-flops F/FA and F/F-D to the set state. Conductor A, connected to one input of NAND gate ND1, goes low. Conductor 5, connected to the second input of the gate, similarly goes low. The three inputs of gate ND2 are connected to conductors F1, F3 and F4, all of which are initially low. Consequently, the output of gate ND2 is initially high. Since this output is connected to an input of NOR gate NR1, the output of the gate is initially low. This output is connected to the third input of gate ND1. Thus, as soon as conductors K and 1 go low, output conductor SE1 of gate ND1 goes high. Since the output of the gate is connected to the J input of flip-flop F/F l, and since the K input of this flip-flop is always low, the next clock pulse on conductor -CLK causes the flip-flop to switch to the set (1) state. The output of gate ND1 is connected only to the J input of flip-flop F/ F-1 via conductor SP1, and consequently of the four flip-flops F/F-l through F/ F-4, only this flip-flop switches state. As shown in the table of FIG. 4, when flip-flops F/F-l through F/F-4 assume respective states 1, 0, 0, 0 the overall system is in state 1. The state diagram of FIG. 3 shows that with an AD input the system should switch from state 0 to state 1. The switch is controlled by gate ND1, as shown in FIG. MA by the notation 0- 1 inside the gate.

Assume next that multipliers M2 and M3 energize their outputs together, a BC input to the recognition logic circuit. Conductor B, connected to one input of gate ND3, goes low. Conductor O, connected to a second input of this gate, similarly goes low. The two inputs to gate ND4 are connected to conductors fi and F2, both of which are low when the system is in state 1. Consequently the output of gate ND4 is high, and since this output is coupled to an input of gate NR2 the output of this gate goes low. The ouput of this gate is connected to the third input of gate ND3, and since all three inputs to this gate are low when the BC input is received, the output of the gate goes high.

Gate ND3 controls the transition from state 1 to state 3 for a BC input, just as gate ND1 controls a transition from state 0 to state 1 for an AD input. The output of gate ND3 is connected to one input of gate NR3, whose output now goes low. Gate NDS inverts the signal so that conductor SFZ, connected to the I input of flip-flop F/F-Z, goes high. The next clock pulse following that which controls the switching of flip-flops F/F-B and F/F-C to the -1 state causes flip-flop F/F2 to switch to the 1 state. The output of gate ND3 is also connected to an input of gate NR4 whose output now goes low. Inverter ND97 causes conductor SP3 to go high, and since this conductor is connected to the J input of flip-flop F/F-3, this flip-flop also switches to the 1 state. Thus, if a BC input is present when a clock pulse is generated, the four flip-flops F/F-l through F/F-4 switch from respective states 1, 0, 0, 0 to respective states 1, 1, 1, 0. As shown in the table of FIG. 4, the latter four respective states represent system state 3, which is the system state into which the circuit switches when a BC input is received while the system is in state 1.

On the other hand, assume that when the system is in state 1 a C input is received without a B input. As described above, because the system is in state 1 the output of gate NR2 is low. The output of this gate is connected to one of the inputs of gate ND6. The other input to the gate is connected to conductor 6. Consequently, when conductor 6 goes low, the output of gate ND6 goes high. Since the output of this gate is connected to an input of gate NR3, just as the output of gate ND3 is connected to another input of gate NR3, flip-flop F/F-2 switches from the 0 to the 1 state when the output of gate ND6 goes high. It should be noted that flip-flop F/F-3 does not switch state because gate ND3 does not operate during a transition from system state 1 to system state 2. Gate ND3 controls the setting of both flip-flops F/F-2 and F/F-3 to switch the system from state 1 to state 3, while gate ND6 controls the setting of only flip-flop F/F-2 to switch the system from state 1 to state 2. Since only flipfiop F/F-2 changes state, the four flip-flops F/ F-1 through F/F-4 assume respective states 1, 1, 0, 0, or as indicated in the table of FIG. 4, system state 2. This is the desired state as shown in the state diagram of FIG. 3 when a C l l input is received without a D input while the system is in state 1.

Assume next that a B input is received while the C input persists. The table of FIG. 4 and the state diagram of FIG. 3 require that the system switch from state 2 to state 3, which in turn entails the setting of only flip-flop F/F3-. When the system switches from state 1 directly to state 3, gate ND3 operates to control the energization of conductor SP3 (along with conductor SP2) via gates NR4 and ND97. However, when the system is in state 2, gate ND3 can not operate even though coductors D and C are low because its third input is derived from the output of gate NR2, one of whose inputs is connected to the output of gate ND4. And this latter gate no longer has. its output high because when the system is in state 2 conductor F2, one of the inputs of gate ND4, is high. For this reason, a difierent gate ND7, is provided to control a switching of the system from state 2 to state 3.

Two of the three inputs to the gate are connected to conductors E and C. The third input of the gate is connected to the output of gate NR5, one of whose inputs is grounded and the other of whose inputs is connected to the output of gate ND8. The two inputs to this latter gate, connected to conductors F2 and F3, are both low when the system is in state 2. Consequently, the gate energizes its output to cause the output of gate NR5 to go low. Gate ND7 operates to cause the output of gate NR4 to go low just as .gate ND3, connected to another input gate NR4, causes the output of gate NR4 to go low when the system switches from state 1 to state 3. With the output of gate NR4 low, the output of gate ND97 goes high. Flip-flop F/F-3 is set (with the application of a clock pulse) and the overall system is switched to state 3 as required by both the state diagram of FIG. 3 and the table of FIG. 4.

If the system is in state 3 and a D input is received, as shown in FIG. 3 the system should switch to state 4, and as shown in FIG. 4 this is accomplished by causing flipflop F/F4 to be set. With a single input D, conductor D is the only one of conductors K through D which is low. This conductor is connected to one input of gate ND9. The output of gate ND10' is high at this time because its three inputs are connected to conductors FT, W and F4, all of which are low when the system is in state 3. Gate NR6 inverts the high output of gate ND10, and since the output is connected to the second input of gate ND9, the output of gate ND9 goes high to control the switching of the system from state 3 to state 4. The output of gate ND9 is connected to one input of gate NR7, the output of which goes low. Inverter ND11 causes the J input of flipfiop -F/F4 to go high and the clock pulse which initially causes flip-flop F/FD to switch to the 1 state similarly causes flip-flop F/F-4 to switch to the 1 state. All of flipflops F/F-1 through F/F-4 are now in the 1 state, and as indicated in FIG. 4 the system is in state =4-the resultant state when a D input is received when the system is in state 3.

It was assumed above that the first input was AD which controlled a switching of the system. from state 0 to state 1. Now assume that the first input is BC rather than AD. As shown in the state diagram of FIG. 3, the system should switch from state 0* to state 5. As shown in the table of FIG. 4, this requires a change only in flip-flop F/F-4 which should switch from the 0 to the 1 state. When conductors E and 6 both go low, two of the inputs of gate ND12 go low. The third input is connected to the output of gate NR1. It will be recalled that when the system is in state 0, the output of this gate is low. Consequently, gate ND12 causes its output to go high, and since the output of this gate is connected to one input of gate NR7, the other input of which is connected to the output of gate ND9, the system operation is the same as that which takes place when the output of gate ND9 goes high. Gate ND9 controls the switching of the system from state 3 to state 4, which as seen in the table of FIG. 4,

simply entails the switching of flip-flop F/F-4 from state 0 to state 1the same operation which is now required to control the switching of the system from state 0 to state 5. Consequently, flip-flop F/F-4 switches to the 1 state and the system is placed in state 5.

When the system. is in state 5, two possible inputs can be expectedD or AD. Assuming that tflip-flops F/F-A and F/F-D both switch to the 1 state together, conductors K and 5, connected to two of the inputs of gate ND13, go low. The third input of the gate is connected to the output of gate NR8. While one input of this gate is grounded, the other is connected to the output of gate ND98. The two inputs to this latter gate are connected to conductors F3 and F4, both of which are low when the system is in state 5. The output of gate ND98 goes high, and the output of gate NR8 goes low. Since all three inputs of gate ND13 are thus low, its output goes high. The output of the gate is connected to an input of gate NR4, which is the gate directly responsible for the switching of flip-flop F/F-3 from the 0 to the 1 state. The output of gate ND13 is similarly connected to an input of gate NR3, which is the gate directly responsible for the switching of flip-flop F/F-Z from the 0 to the 1 state. Consequently, both of flip-flops F/F-Z and F F3 switch from the 0 to the 1 state-the two flip-flops which must thus switch to control a system transition from state 5 to state 7 as seen in FIG. 4, and as required by the state diagram of FIG. 3, when an AD input is received while the system is in state 5.

On the other hand, assume that the D input is received before the A input. Conductor D is the only one of conductors K through D which goes low. This conductor is connected to one input of gate ND14. The other input to the gate is connected to the output of gate NR8 which, as described above, is low when the system is in state 5. Consequently, gate ND14 operates to energize one input of gate NR4. Unlike a transition from state 5 to state 7, gate NR4 operates alone rather than with gate NR3. Consequently, only flip-flop F F-3 changes from the 0 to the 1 state. This is the operation required by the table of FIG. 4 when the system switches from state 5 to state 6.

With the system in state 6 and a D input still present, assume that the A input is received. Conductors K and D are now both low and since they are connected to two of the inputs of gate ND15', two of the inputs to this gate are low. The third input of the gate is connected to the output of gate NR9. While one input to this gate is grounded, the other is connected to the output of gate ND16. The two inputs to this gate are connected to conductors F2 and W, both of which are low when the system is in state 6 as seen in the table of FIG. 4. Consequently, the output of gate ND'16 goes high and the output of gate NR9 goes low. Since all three inputs to gate ND15 are now low, one input of gate NR3 is energized. This is the gate which, when any one of its inputs is energized, causes flip-flop F/F-Z to switch from the 0 to the l state. This is the only operation required when the system switches from state 6 to state 7, as seen in the table of FIG. 4, which operation is required when an AD input is received while the system is in state 6, as seen from the state diagram of FIG. 3.

With the system in state 7, assume that only a C input is received. Conductor 6 goes low so that one of the inputs of gate ND17 goes low. The other input of this gate is connected to the output of gate NR10, one of whose inputs is grounded and the other of whose inputs is connected to the output of gate ND18. The three inputs of gate ND18 are connected to conductors F1, F3 and T l all of which are low when the system is in state 7 as seen from the table of FIG. 4. The output of gate ND18 thus goes high and the output of gate NR10 thus goes low. The output of gate ND17, connected to the K input of fiip'flop F/F4, goes high. At this time, the J input of the fiip-fiop is low because gate ND11 does not energize conductor SP4. With the J input of the flip-flop low and the K input of the flip-flop high, the clock pulse on conductor CLK causes the flip-flop to switch to the state. (This is the only instance in which one of flip-flops F/ F-1 through F/F-4 switches from the 1 to the 0 state, other than with the energization of the R terminals of the flipfiops. It is for this reason that the K inputs of flip-flops F/F-l through F F-3 are all grounded while the K input of flip-flop F/F-4 is allowed to go high with the operation of gate ND17.) Flip-flops F/F-l through F/F-3 remain in respective states 0, 1, 1, and as seen from the table of FIG. 4 when flip-flop F/F-4 switches from the 1 to the 0 state, the system switches from state 7 to state '8. As seen from the state diagram of FIG. 3, this is the required operation when a C input is received alone while the system is in state 7.

Depending on the operations of multipliers M1 through M4 (FIG. 7), flip-flops F/F-A through F/F-D continuously change state. Whenever a multiplier output is high, the next clock pulse switches the associated flip-flop to the 1 state. Whenever a multiplier output goes low, the next clock pulse switches the flip-flop back to the 0 state. Flipfiops F/F-A through F/F-D thus represent the instantaneous values of inputs A, B, C, D as represented on FIG. 1. Flip-flops F/F-l. through F/F-4, on the other hand, comprise the memory of the circuit-they represent the instantaneous system state dependent upon the prior sequence of the multiplier energizations, and also control transitions to succeeding states dependent upon the values of the instantaneous inputs. Assuming that the system state initially went from state 0 to either of states 1 or 5, the system can end up in any one of the eight states 1 through 8. When the negative strobe pulse is applied, the system switches to one of the states 9 through 16 from respective ones of initial states 1 through 8 as shown in FIG. 3. This final system state is represented by one of conductors '51-9 through 51-16 going low. Flip-flops F/F-l through F/F-4 are no longer required for representing the system state. The flip-flops are simply used to control one of conductors 51-9 through 51-16 to go low in accordance with which of states 1 through 8 is represented by the flip-flops when the strobe pulse is generated.

It is necessary at this point to consider how the system reaches the terminal states 9-16. Consider first terminal state 15. One input of gate ND20 (FIG. 11B) is connected to the output of gate NR2. One of the inputs to the latter gate is connected to the output of gate ND4, and the other input is connected to ground. As described above, when the system is in state 1, the output of gate ND4 is high. Consequently, with the system in state 1 the output of gate NR2 goes low. When conductor STROBE goes negative with the generation of the strobe pulse, the other input of gate ND20 also goes low. The output of gate ND20 goes high, and the signal is inverted by inverter ND21. Consequently, when the system is in state 1, the generation of the strobe pulse results in conductor 51-15 going low to represent terminal system state 15.

Consider next the generation of the strobe pulse while the system is in state 5. The state diagram of FIG. 3 shows that the system should switch to state 16. One input of gate ND22 is connected to the output of gate NR8, one of whose inputs is connected to the output of gate ND98. (The other input of gate NR8 is grounded.) As described above, the output of this gate is low when the system is in state 5. The other input of gate ND22 is connected to conductor -STROBE, and when this conductor goes negative with the generation of the strobe pulse the output of gate ND22 goes high. The signal is inverted by gate ND23 and conductor 51-16 goes low to represent terminal system state 16.

Assume now that the system is in state 2 when the strobe pulse is generated. Referring to the state diagram of FIG, 3, it is seen that the system must switch to a final state 9. As described above, when the system is in state 2 the output of gate NR is low. This output is connected to one input of gate ND24. The other input of the gate is connected to conductor STROBE and when the strobe pulse is gen- 14 erated both inputs to the gate are low. The output goes high but is inverted by gate ND25. Conductor 51-9 goes low as required.

If the system is in state 3 when the strobe pulse is generated, the output of gate NR6 is low. This output is coupled to one input of gate ND26, the other input of which is connected to the STROBE conductor. When the strobe pulse is generated the output of the gate goes high but is inverted by gate ND27 to cause conductor 51-10 to go low, representing system state 10.

If the strobe pulse is generated when the system is in state 4, referring to the table of FIG. 4 it is seen that flipflop F/ F-1 is in the 1 state and flip-flop F/F-4 is similarly in the 1 state. Only in such a case are both of conductors F1 and F4 low. Both of these conductors are coupled to the two inputs of gate ND28 whose output is thus high when the system is in state 4. The output of the gate is coupled to an input of gate NR16, whose output is thus low when the system is in state 4. Since the output of this gate is connected to one input of gate ND29, and the other input of this gate is connected to the STROBE conductor, with the generation of the strobe pulse the output of gate ND29 goes high. It is inverted by gate ND30 to cause conductor 51-11 to go low, representing a final system state 11.

When the system is in state 6, the output of gate NR9 is low. This output is connected to one input of gate ND31, the other input of which is conected to conductor STROBE. The strobe pulse causes the output of the gate to go high and the signal to be inverted by gate ND32. Conductor 51-12 goes low to indicate a final system state 12.

If the system is in state 7, the output of gate NR10 is low. The two inputs to gate ND33 are connected to this output and to conductor -STROBE. The strobe pulse causes the output of the gate to go high and the signal to be inverted by gate ND34. Conductor 51-13 goes low to indicate a final system state 13.

Finally, if the system is in state 8 when the strobe pulse is generated, as seen from table of FIG. 4, flip-flop F/F-l is in the 0 state and flip-flop F/F-4 is in the 0 state. All of conductors F1, F2 and F4 are low. Since these three conductors are connected to the three input of gate ND35, the output of the gate is high. The outputs s connected to an input of inverter NR17 whose output is low. The output of gate NR17 is connected to one input of gate ND37, the other input to which is connected to conductor STROBE. The strobe pulse causes the output of gate ND37 to go high, and the signal is inverted by gate ND38 to cause conductor 51-14 to go low, representing a final system state 14.

Depending on the sequence of inputs A, B, C and D, one of conductors 51-9 through 51-16 goes low with the generation of the strobe pulse. The strobe pulse is not generated until after the ECG waveform has terminated. Immediately after the strobe pulse is generated the reset pulse +R is generated. (The timing control circuit 30 will be described below.) This pulse resets all of flip-flops F/F-l through F/F-4, as described above, to the 0 states so that the recognition logic circuit represents a system state 0. Also, all of flip-flops F/F-A through F/F-D are reset in their 0 states at this time as a result of the first clock pulse which arrived immediately after each respect1ve multiplier output went to zero at the end of the ECG waveform. Consequently, the system is in a condition to determine the nature of the next ECG wa'veform.

FIGS. 12A and 12Bmorphology detector circuit Part I Morphology detector 60 performs two functions. First, It stores the morphology pattern numbers (states 9 through 16) which occur during the learning interval. Second, it compares the stored state numbers with those states occurring later. If a new state occurs which is not 

